School of Medicine

We have implemented a new clinical curriculum based upon a yearly 13 rotation block schedule, a significant change from the traditional 12 one-month block rotation schedule.  Each block rotation is now 4 weeks long.  We now have one additional clinical rotation each year to maximize your clinical exposure.  Currently we have added a Neurological ICU rotation in the EM-1 year and a Hand Surgery rotation in the EM-2 year.  We are also in the second year of a phased increase in resident complement from 12 to 14 residents in each class.  For the 2009-2010 year, the EM-3 class continues on the 12-month block schedule; next year the 13 rotation block schedule will be fully implemented.

Curriculum – Rotations

* All EM blocks during the EM-2 year include shifts at both Detroit Receiving Hospital (DRH) and Children’s Hospital of Michigan (CHM). This provides seasonal variation in the pediatric training experience and assures pediatric exposure throughout the year.

** All EM months during the EM-3 year consist of a repeated “run” of shifts at 3 different clinical ED sites; including DRH both acute and “rapid” care (urgent care setting), CHM for continuity in pediatric training, and at Huron Valley-Sinai Hospital (HV-S) for a community emergency medicine experience with pediatric exposure as well. 

Longitudinal Administrative Curriculum
All EM residents are provided with a self-study Administration Curriculum that must be completed by graduation. The curriculum has three components:

1. Selected readings in four general topics of EM administration, and a multiple choice quiz to complete for each topic
2. Continuous quality improvement activities, and
3. Attendance at selected administrative departmental/institutional meetings.

Toxicology Experience
We do require that the medical toxicology rotation is completed during one of the three elective blocks over the course of residency.  This is taught at our poison control center located in Children’s Hospital of Michigan.  This rotation is attended by emergency medicine residents and medical students from South East Michigan.

Overall Curriculum Experience
Our program is designed to provide you with a robust and diverse clinical experience by rotating through four different EM clinical sites within the Detroit Medical Center.  DRH provides a high-volume urban adult patient population in a nationally recognized Level 1 trauma center throughout your residency training.  Pediatric training is based at CHM.  EM-1 residents receive a concentrated and focused pediatric EM experience by completing 2 blocks in the CHM ED.  During the EM-2 and EM-3 years, pediatric training at CHM continues with an average of 3 shifts during each block.  There is also a block of Pediatric ICU during the EM-2 year.  The community emergency medicine experience occurs during the EM-3 year working on average 4 shifts at HV-S during each EM block.  Lastly, a unique intensive adult medical EM experience is gained at Harper University Hospital during the EM-3 year.  The EM faculty at all institutions are committed to providing a supportive educational and clinical teaching environment. 

EM-1 Curriculum
The EM-1 curriculum is designed to provide a broad clinical experience within several medical specialties.  The first block rotation of the year is an orientation program that includes a series of lectures on topics such as chest pain, difficulty in breathing, disorders of glucose metabolism,  ECG interpretation, and hands-on procedural workshops covering central venous access, lumbar puncture, slit lamp, advance airway techniques and others.  You will also complete rotations giving you clinical exposure in surgical/trauma management, critical care in the medical and neurological ICUs, and obstetrical care at Hutzel Women’s Hospital, intubation and airway management as well as orthopedic injuries.  You will also have the opportunity to develop your clinical skills in the applications and use of emergency ultrasound during a block rotation devoted, airway management, and treatment of orthopedic injuries.  The remainder of the time is spent in the emergency department setting at DRH and CHM.  There is an elective block in each year that can be used to pursue interests pertinent to emergency medicine.  The experience gained during the EM-1 year serves as the foundation for the final two years of residency, which emphasize your training in the emergency department and experience resuscitating and stabilizing critically ill or injured patients. 

EM-2 Curriculum
The EM-2 year emphasizes your development of clinical skills necessary to evaluate and treat patients in the emergency department setting.  You will work closely with EM faculty to develop your ability to effectively investigate the chief complaint, consider diagnoses “not to miss”, and discern which diagnostic tests or studies are necessary to either identify or exclude emergency conditions.  You will become the team leader in resuscitation, and learn to approach patients with life or limb threats in an organized and prioritized manner.  You will multitask and work to maintain patient flow as you gain confidence in your clinical decisions and ability to disposition patients from the ED.  Critical care blocks in the medical ICU, pediatric ICU, and CCU will help expand your critical care skills and knowledge.  A hand surgery block has been added to the EM-2 year to help you develop the clinical skills (x-ray interpretation, wound management, immobilization and splinting) to properly evaluate and treat conditions and injuries of the hand.
We also provide a unique EM-based rotation called ED Critical Care (ED-CC). The main objectives of this rotation focus on providing EM-2 residents with a concentrated bedside experience managing critically ill ED patients.  You will spend 100% of your time participating in, learning from, and gaining perspective about critical care management IN the emergency department; this is NOT an ICU-based rotation.  Dr. Rob Sherwin is the rotation supervisor and provides educational support throughout the block. The ED-CC resident is responsible for participating in all medical and trauma codes during their shift.  You function as an adjunct floating resident and operate under the clinical supervision of the treating physician.  Furthermore, you may be paged to assist with other ED patients deemed to be appropriate for critical care by the treating EM attending physician.  The ED-CC resident can expect to benefit from 70-80 critical care ED cases during the rotation in addition to assisting with a number of procedures.  “Downtime” activities include completing a required reading list, patient follow-up assessments and patient logs.  Every resident completes the online NIH Stroke Scale Certification course thus providing comprehensive training in stroke care.  DRH is a stroke care center so it is important to be well trained in acute stroke care. Didactic lectures will be provided on several pertinent critical care topics, including sepsis, oxygen delivery, shock, induced hypothermia, mechanical ventilation, difficult airway, antibiotics, vasopressors, ACLS pharmacy, RSI pharmacology and pre-hospital critical care.  Overall the goal of the ED-CC rotation is to make you competent in providing state-of-the-art care to the patients most critically ill.

EM-3 Curriculum
This year is dedicated to the “complete” practice of emergency medicine.  During the EM-3 year, each EM block will have you working shifts at DRH, CHM for continuing pediatric experience, and Huron Valley-Sinai Hospital for the community EM training.  Each clinical site will expose you to a unique clinical experience, the sum of which will prepare you for virtually any academic or clinical practice for your emergency medicine career.  The DRH clinical experience includes both medical and trauma module shifts.  You will assume responsibility for your entire module with teaching responsibility toward junior residents and medical students.  You will also see patients in the DRH ambulatory rapid care clinic, an urgent care setting. This gives you the opportunity to see a large volume of patients with less acute complaints, learning to trust your clinical judgment to diagnose and treat conditions, without the necessity of multiple tests and diagnostic studies.  You will continue adding pediatric clinical experience at CHM under the guidance and supervision of board certified pediatric emergency medicine physicians and fellows-in-training.  Huron-Valley Sinai is a very busy community hospital where you will see both adult and pediatric patients.  This experience will develop your communication skills in dealing with primary medical doctors and consultants, and perspective learning to determine when patients need to be transferred to a higher level facility.  Lastly, one block at Harper University Hospital will give you valuable experience treating challenging adult medical patients with multiple complex co-morbid conditions.  The EM-3 year will contribute significantly to your growing “bank” of clinical experience, confidence in your clinical ability and judgment, and skill as an emergency medicine physician reading for independent practice.

Unique Program Features

High Fidelity Human Simulation: A new simulation center has opened at the recently completed Mazurek Educational Commons at the Wayne State University School of Medicine.  Dr. Rosemarie Fernandez, who is a National leader in the field of simulation, runs our simulation curriculum.  All residents participate in multiple procedures and “whole body” simulations throughout their three years of residency.  Please refer to the Simulation section for further details.

Web Educational Resource

The Receiving Educational website (www.drhem.com) is a powerful web-based tool that augments resident education, communication, and productivity.  Using simple, freely available blog software, this inter-disciplinary web-based forum integrates faculty-created, case-based learning modules with critical essays and articles related to the practice of emergency medicine. Users no longer simply consume and download information from the web; they create and interact with it.

Receiving is updated weekly.  Every post has its own URL and tags allowing for quick and easy searchability and archiving.  Receiving is linked to an RSS (Really Simple Syndication) feed, allowing users to get the latest information without having to continually check the website for updates.  Residents have access to the website anytime and anywhere that the Internet is available (e.g., home computer, hospital computer, iPhone™, BlackBerry™), bringing the classroom to them.

This unique blend of topics and the ability to create a virtual interactive community creates a dynamic learning environment and directly enhances resident education. Receiving serves as a core educational tool for our residency, presenting interesting and relevant emergency medicine information in a collaborative and instructional environment.